# ORTHOPEDIC & SPINE THERAPY OF CLINTONVILLE, SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821105354
- **Authorized official:** PAUL STEVEN BARNETT (OWNER-PRESIDENT)
- **Authorized official phone:** (920) 257-2000

## Contact information

- **Practice address:** 205 W GREEN BAY ST, SHAWANO, WI 54166-2333
- **Practice address phone:** (715) 526-5433
- **Practice address fax:** (715) 526-6930
- **Mailing address:** 4000 N. PROVIDENCE AVENUE, APPLETON, WI 54913-8018
- **Mailing address phone:** (920) 257-2000
- **Mailing address fax:** (920) 257-2004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | WI | Yes |

## Other

- **Enumeration date:** 08/23/2006
- **Last updated:** 06/21/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1019870005 | AMERICHOICE | WI |
| 01 | — | 128873 | HEALTH PARTNERS | WI |
| 05 | — | 40423300 | — | WI |
| 05 | — | 41746200 | — | WI |
| 01 | — | CH3959 | RAILROAD MEDICARE | WI |